Provider Demographics
NPI:1952530750
Name:THORNTON, WILLIAM FREDERICK
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:THORNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 21ST ST NE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-1627
Mailing Address - Country:US
Mailing Address - Phone:701-662-4202
Mailing Address - Fax:701-662-4202
Practice Address - Street 1:1031 7TH ST NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2719
Practice Address - Country:US
Practice Address - Phone:701-662-2131
Practice Address - Fax:701-662-9651
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007663367500000X
MT103222367500000X
WV96024367500000X
NDR44275367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered